Pandemic Vaccine Allocation Optimizing Efficiency, Safety and Fairness

A simulation platform that optimizes pandemic vaccine allocation to low-income countries, emphasizing fairness and safety. Applications also include preparedness training.

Dr. Peter Thanisch, Associate Professor at Tampere University, Finland and the director of Operandum Est Limited. Dr. Thanisch is currently working under contract for the World Health Organization, Geneva.

When responding agencies distribute pandemic vaccine secured for low-income countries, there will be insufficient vaccine to meet initial needs. The consequent rationing is hard to optimize because each vaccine product has distinctive characteristics (e.g., dosage regime, bulkiness, and storage temperature) and each recipient country has distinctive characteristics (e.g., urbanicity, obesity, age demographic, previous partial dosage deployment, prevalence of specific strains). Thus, for each distinct vaccine/country pair there is a distinct utility that impacts optimal distribution.

For a simple example, suppose we have two vaccine products, V1 and V2, and two countries, C1 and C2. V1 requires an extra dose for obese people and V2 requires an extra dose for senior people. C1 has a larger proportion of obese people compared to C2 and C2 has a larger proportion of seniors compared to C1. Other things being equal, it can be advantageous to allocate V1 to C2 and V2 to C1.
Similarly, there will be an unavoidable wastage for each vaccine/country combination determined by the vial size, out-of-fridge tolerance of the vaccine and the average vaccination session size. Our algorithm optimizes the overall vaccine allocation, given the available vaccine and the stated needs of countries.

Our “target audience” comprises low-income countries that rely on donations, or similar schemes, to secure pandemic vaccines. The solution increases the number of vaccine treatments that they obtain and reduces the number of potentially high-risk allocations.

Our application transforms the role of beneficiary countries from being passive recipients of a vaccine allocation to being genuine contributors in determining the suitability of proposed vaccine allocations, given their resources, e.g. cold–chain storage and logistics. We are also assisting countries to improve their readiness to respond to a future pandemic by providing a simulation platform for training and preparedness exercises.

The “target audience” also comprises the responding agencies (WHO, UNICEF, GAVI, CEPI, etc.). We shall be developing our solution with their requirements taken into account.

All three members of our team are contractors at WHO, working on medicines shortages and the control of vaccine wastage. In those roles, we are in frequent contact with representatives of health authorities in low-income countries. We are highly aware that each low-income country has its own distinctive set of challenges and we have deliberately designed our software in cognizance of that situation.

The “public good” aligns with the Global Public Good of the World Health Organization (ACT-A: COVID 19 Vaccines, Tests and Therapies) and is identified in World Health Assembly Resolution 69.25, Addressing the global problem of shortages and stock outs of medicines. The technical components may be considered in three additional headings.

(1) Our solution addresses stewardship of scares vaccines and medicines and maximizes the number of people that can be immunized or treated from a given number of doses.

(2) It is transparent and demonstrably fair.

(3) Hitherto, the LMIC beneficiary countries have been passive recipients, but our platform encourages active participation in analyzing the implications of proposed allocations. This includes, for example, the ability of each beneficiary country to estimate the storage impact and the wastage factor of a proposed deployment. 

Vaccine wastage is a major problem in low-income countries. A pandemic vaccine wastage estimation tool is an early deliverable from our project. We intend to make the tool freely available to all low-income countries.

A pandemic vaccine wastage estimation tool is an early deliverable from our project. We intend to make the tool freely available to all low-income countries.

The impact of our solution is that, globally, more people can be vaccinated from a given quantity of donated vaccine. This is partly achieved through matching vaccine products to countries and partly by controlling wastage. Our algorithm also identifies and avoids situations where a beneficiary country’s limited cold-chain capacity can be overwhelmed by the vaccine allocation. 

By getting the users from beneficiary countries to analyze the impact of proposed vaccine deployments, they can be better prepared for its arrival. Importantly, we are providing a platform that allows the country users to gain a better understanding of the impact of a proposed vaccine allocation on their cold chain, logistics and vaccination teams. By developing the same underlying platform for training and simulation, as well as the allocation itself, our intention is to improve global preparedness.

In the past, for low income countries, vaccine allocation has been perceived as donor/(passive) recipient process. A lesson from COVID-19 is that, no matter how poor a country might be, we must all act in partnership. The active role we ascribe to countries' response teams reflects the reality that we need the overall operation to be done in that spirit of partnership.

If we receive support from Trinity Challenge, we shall be able to release our vaccine wastage estimation tool by Q4 2021. As a cloud-based application, that tool can be made available globally. It will help low-income countries to plan a vaccination campaign so that they minimize vaccine wastage due to the limited fridge life of opened vaccine vials. This will increase the number of full treatments that a country gets from a given quantity of donated vaccine. A more accurate estimate of wastage also makes it easier for countries to plan logistics and cold chain capacity for the vaccine roll out.

Within one year, we shall have implemented a simulation platform that can be used for preparedness and training exercises. This platform shall be tested in an exercise involving users from beneficiary countries. The feedback from the exercise will allow us to refine the platform and create a full set of documentation.

Within 18 months, we shall have scope out the integrate roadmap for our application with the software, such as co-operative work tools, used by responding agencies for vaccine allocation.

As a cloud app, the pandemic vaccine wastage estimation tool usage can be monitored. We shall be soliciting feedback from users. (The equivalent tool for routine vaccination wastage estimation is very widely used.)

We have designed our software so that it examines how well a pandemic response worked out in practice. We have already used the software to evaluate the vaccine allocation for the 2010 response to pandemic H1N1 influenza. We intend to repeat the analysis, when appropriate, for the 2021 Covid-19 response.  We already have access to substantial data on the vaccine products and on the beneficiary countries. We are only lacking the week-by-week record of changes to the production estimates.

We shall also be conducting an exercise involving real users from health authorities in low-income countries. We shall be assessing their reactions to our platform.  In particular, we can measure the users' ability to identify vaccination program characteristics that fit well with a schedule of vaccine deployment in the exercise. We shall also be obtaining feedback on their user experience with our platform. 

 We regard the two significant barriers as being finance and policy. Finance is required mainly for the analysis, implementation, testing and documentation of the proposed system. There are two potential barriers under the “policy” heading.  First, we need to persuade a representative sample of beneficiary countries to evaluate the system at key development milestones. Secondly, a public health emergency response is undertaken by several different agencies. For example, vaccine allocation for the Covid-19 response has been the responsibility of the COVAX Facility, a complex partnership including GAVI, WHO, UNICEF, and CEPI. Although there is no guarantee that the same mix of partner organizations will be involved in vaccine allocation for future pandemic responses, our approach is to get buy-in from the organizations involved in the current allocation and deployment scheme. We have already taken preliminary steps by making presentations to WHO and CEPI. The response has been favorable.

An additional barrier is getting a good level of involvement from appropriate personnel in beneficiary countries. The poorer countries' healthcare systems may still be suffering from the effects of the current pandemic when we are ready to test our software. This could make it hard for us to recruit the best set of users.  

Peter Thanisch: Tampere University, Finland (Associate Professor)

Paul Colrain, Tim Kempster and Peter Thanisch: World Health Organization (contractors)

We believe that we have made a good start on implementing, and even validating, the concept. However, the project is not at a stage of maturity where we can persuade the responding agencies to adopt it. We need to be able to demonstrate clearly and quantitatively what are the advantages of our approach. Support from Trinity Challenge will allow us to carry out the developments to transform our software into a platform for applications related to vaccine allocation. 

However, we also need the prestige of Trinity Challenge and its Member organizations in order to give our project credibility. That credibility is needed to recruit relevant users from beneficiary countries to test our platform. However, it is also needed to attract attention at an appropriate level in the responding agencies (GAVI,CEPI, UNICEF and WHO). If we can explain and demonstrate our project to representatives of Trinity Challenge's Member organizations, it is highly likely that those representatives will be able to assist us in approaching the right people in the responding agencies. (We already have contacts at the technical level, of course.)

Our existing contacts in WHO are able to assist us in recruiting users from the healthcare systems of low-income countries. 

Although we have relevant contacts in several beneficiary countries, as well as WHO, it would also be fruitful to discuss the development with other relevant organizations, in particular GAVI, CEPI and UNICEF. We have already presented to the concept to a senior representative from GAVI (and we have received a favorable response). We need a Trinity Challenge Member organization that has contacts at the right levels in the responding agencies.